Splinting Options for Treating a Mallet Finger

When your patient presents with a drooping fingertip after catching it in a drawer, you're likely looking at a mallet finger injury. This seemingly minor trauma can lead to significant functional impairment if not properly addressed, making your choice of splinting solution critical to patient outcomes.

Understanding Mallet Finger 

Mallet finger occurs when the extensor tendon at the distal interphalangeal (DIP) joint becomes stretched, avulsed, or completely ruptured. While commonly called "baseball finger" due to its prevalence in sports, this injury affects patients across all demographics and activity levels. The mechanism typically involves forced flexion of an extended finger, creating a sudden tension that overwhelms the tendon's capacity.

What makes this injury particularly challenging is that while patients can passively extend the affected finger, they cannot maintain extension without external support. This loss of active extension significantly impacts fine motor function and activities of daily living.

Symptoms of Mallet Finger

• Loss of active extension of the distal interphalangeal (DIP) joint
• Localized swelling around the fingertip
• Possible bruising or open wound over the dorsum of the DIPJ
• Pain with attempted extension
• Maintained passive range of motion

The diagnostic hallmark remains the patient's inability to actively extend the DIP joint while retaining passive extension capability. This distinction is crucial for differentiating mallet finger from other digital injuries.

Treatment for Mallet Finger

Research consistently demonstrates that early intervention with appropriate splinting yields the best functional outcomes. The standard protocol involves continuous DIP joint immobilization in slight hyperextension for 4-6 weeks, followed by a gradual weaning protocol.

Untreated mallet finger may progress to secondary deformities, including PIP joint hyperextension (swan neck deformity), which significantly complicates treatment.

Finger Splinting Options for Mallet Finger

1. Aluminum and Foam Strips:

 Advantages:

• Light weight and readily available
• Cost-effective for initial stabilization
• Immediate availability in most clinical settings

Disadvantages:

• Requires tape adherence, creating potential skin irritation
• Prevents normal hand hygiene, increasing infection risk
• Foam degradation necessitates frequent replacements
• Limited finger function during treatment
• Skin maceration from poor ventilation

Best Use Case: Emergency stabilization or short-term immobilization when other options aren't immediately available.

(Alex Orthopedic Aluminum Splint)

2. Stax Splint:

 Advantages:

• Reliable DIP joint immobilization
• Maintains consistent extension positioning

 Disadvantages:

• Must be taped on
• Complete fingertip coverage eliminates tactile sensation
• Challenging sizing process for optimal fit
• Hygiene maintenance difficulties
• Patient compliance issues due to functional limitations
• Skin maceration concerns with prolonged use

(Stax Finger Splint)

Best Use Case: Patients requiring maximum immobilization control with minimal concern for functional use during treatment.

3. Oval-8® Finger Splint

 Advantages:

• Functional Design: Open fingertip design preserves tactile sensation and enables continued finger use
• Optimal Ventilation: Open architecture prevents skin maceration while maintaining joint stability
• Dynamic Fit: Built-in size adjustability accommodates swelling fluctuations throughout healing
• Patient Compliance: Easy removal for hygiene and skin care improves adherence
• Customization Options: 14 heat-adjustable sizes with optional gel sheeting for enhanced comfort
• Professional Versatility: Available in classic beige and clear options for patient preference

 Clinical Considerations:

• May require professional heat adjustment for optimal fit
• Potential for displacement in cold weather or with significant swelling reduction

Best Use Case: Most cases of mallet finger, especially when preserving finger mobility during treatment is essential for the patient’s daily activities or work requirements.

          Oval-8 Finger Splint

Post-Treatment Monitoring and Outcomes

Successful mallet finger treatment requires systematic follow-up care. If functional improvement plateaus after 4-6 weeks of conservative treatment, consider referral for surgical evaluation. 

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